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RRC520004-00 MCHS FRANCISCAN HEALTHCARE INC (Active)
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Main Details
Name
MCHS FRANCISCAN HEALTHCARE INC
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC520004-00
Medicare Provider Number
520004
Additional Details
Current Program Status
Active
Registration Date
4/12/2021
Participating Start Date
7/1/2021
Participating Approval Date
5/17/2021
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Mayo Clinic Health System
Tanner Holst, Regional Chair-Administration SWWI
(608) 392-9705
Primary Contact
Mayo Clinic Health System
Matt Lemin, Program Manager
(507) 293-3853
Addresses
Street Address
700 WEST AVE SOUTH
LA CROSSE, WI 54601-4783
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2018; Terminated 7/1/2019; Reinstated 7/1/2021.
05/17/2021
Participated starting 7/1/2018; Terminated 7/1/2019; Reinstated 7/1/2021.
05/07/2021
Hospital previously participated as DSH520004 from 1/1/2012 through [conversion start date – 7/1/2018]; converted to a RRC hospital effective 7/1/2018.
04/19/2018
April 2025
April 2025
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